Organization
ANESTHESIOLOGY MEDICAL SERVICES PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY H TITLE MD (PRESIDENT)
(270) 684-8611
Entity
Organization
Contact information
Practice address
2211 MAYFAIR AVE, SUITE 206, OWENSBORO, KY 42301
(270) 684-8611
(270) 684-1186
Mailing address
2211 MAYFAIR AVE, SUITE 206, OWENSBORO, KY 42301
(270) 684-8611
(270) 684-1186
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1172699
PASSPORT
—
01
—
221317
ANTHEM
—
05
—
65937450
—
KY
01
—
74900408
MEDICAID CRNAS
KY
Enumeration date
07/08/2006
Last updated
08/22/2020
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